This interactive bulletin reports on the latest epidemiology of
COVID-19, influenza, respiratory syncytial virus (RSV) and other
respiratory viruses (ORVs) in Ireland. HPSC monitors several integrated
respiratory virus surveillance systems that are included in this
bulletin. This report will be published weekly during the winter season
(week 40 to week 20).
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Key messages
During week 49 2024, influenza activity and positivity continued to
increase. Sentinel GP influenza positivity was 26.0%, above the 10%
positivity threshold and indicating that influenza viruses are
circulating in the community. RSV cases and hospitalisations continued
to increase, particularly in those aged less than five years. COVID-19
activity remained at low levels. Rhino or enterovirus continued to
circulate but detections have been decreasing over the last four weeks.
Other seasonal respiratory viruses remained at low levels.
Summary for week 49
2024
Primary Care Surveillance
The sentinel GP Acute Respiratory Infection (ARI) consultation rate
increased for the fifth consecutive week to 110.9/100,000 population in
week 49, with the highest rates in those aged <5 years. Sentinel GP
positivity for influenza was above the 10% positivity threshold levels
at 26% and has been increasing in recent weeks. Rhino or enterovirus
positivity was above the threshold but has been decreasing for the last
four weeks. All other respiratory pathogens remained below the
threshold. The proportion of GPOOH calls for self-reported cough was
over the threshold for all age groups in week 49. Calls for
self-reported flu were stable in all groups and remained below the
threshold in week 49.
COVID-19
COVID-19 activity remained at low levels across all indicators in
week 49. COVID-19 cases decreased by 17.0% from 138 cases notified in
week 48 to 114 cases in week 49. Hospitalised cases decreased by 31.0%,
with 54 cases in week 48 compared to 37 cases in week 49. ICU admissions
and deaths remained low. The increasing prevalence of the XEC variant
stabilised and accounted for 37.6% of sequences between weeks 44 and 48
2024. SARS-CoV-2 viral loads in wastewater decreased in most catchment
areas in week 49 2024.
Influenza
During week 49 2024 influenza activity continued to increase. The
overall notification rate was 10.3/100,000 population and was highest in
those aged ≥80 years. The number of notified influenza cases increased
by 91% from 277 in week 48 2024 to 528 cases in week 49 2024. There were
149 hospitalisations and two ICU admissions. No deaths were reported
during week 49 2024. For the season to date (weeks 40-49 2024), eight
ICU admissions and three deaths have been reported. Influenza A virus is
the dominant type accounting for 91% of cases.
RSV
The number of RSV cases were stable during week 49, there were 305
cases compared to 331 in week 48. The overall notification rate was
5.9/100,000 population and was highest in those aged less than one year
at 160.9/100,000 population. There were 113 hospitalisations and three
ICU admissions in week 49. For the season to date, 14 ICU admissions and
no deaths have been reported (weeks 40-49 2024).
Severe Acute Respiratory Infection (SARI)
Based on data from three sentinel hospital sites, in week 49, the
number of SARI cases reported increased by 25.4% to 79 cases compared to
63 cases in week 48. Compared to the previous week, in week 49,
influenza positivity increased from 15.7% to 20.0%, RSV positivity
increased from 15.7% to 20.0%, and SARS-CoV-2 positivity remained
relatively stable from 2.0% to 2.9%.
Outbreaks
COVID-19 outbreaks decreased in week 49 compared to week 48 2024. A
total of six COVID-19 outbreaks were reported, two in hospitals and one
in a nursing home. During week 49, there were eight influenza outbreaks
(six in hospitals, one in a nursing home and one in a residential
institution), five RSV outbreaks (one in a hospital and four in nursing
homes) and two other ARI outbreaks (one in a community hospital and one
in a nursing home) reported.
Technical notes
General
Data are provisional and subject to ongoing review, validation and
update. As a result, figures in this report may differ from previously
published figures.
The weekly calendar runs from Sunday to Saturday for respiratory
virus notifications on CIDR (as per the Infectious Disease Regulations
1982 and subsequent amendments) and Monday to Sunday for the sentinel GP
and SARI surveillance systems (as per ISO week). Further information on
epidemiological dates and weeks can be found on the HPSC website.
Definitions
The case definitions for COVID-19, influenza and RSV are available
here. Only data on laboratory-confirmed cases, including cases diagnosed
using near patient molecular tests, are included in this report.
Sentinel GP ARI consultations are consultations to sentinel GP
practices for Acute Respiratory Infection (ARI), with ARI defined as
Sudden onset of symptoms AND at least one of the following four
respiratory symptoms: Cough, sore throat, shortness of breath, coryza
AND a clinician’s judgement that the illness is due to an infection.
GP out of hours calls refer to calls to GP out of hours services from
persons with self-reported clinical symptoms of ‘flu’ or ‘cough’.
Emergency Department cases refer to cases treated in emergency
departments, with no indication on CIDR that they have subsequently been
admitted to hospital.
Hospitalised cases are inpatients with laboratory confirmed
SARS-CoV-2, influenza or RSV and includes inpatients with incidental
infections, where the infection is not the reason for their
admission.
Bed occupancy refers to the number of laboratory confirmed cases
admitted to acute inpatient sites at 08:00 hrs on the day of
reporting.
A SARI case is defined as a person hospitalised for at least 24 hours
with acute respiratory infection, with at least one of the following
symptoms: cough, fever, shortness of breath OR sudden onset of anosmia,
ageusia or dysgeusia with onset of symptoms within 14 days prior to
hospital admission. A SARI case refers to an individual patient episode
of care.
As of September 2024, ICU admissions for COVID-19, influenza and RSV
refer to those admitted to intensive care where COVID-19, influenza or
RSV were the primary or contributory cause of admission. Prior to
September 2024, ICU admissions for influenza and RSV included all
admissions where the patient tested positive for influenza or RSV,
irrespective of whether these pathogens were the cause of admission.
COVID-19, influenza and RSV deaths are defined as a death in a person
with laboratory confirmed COVID-19, influenza or RSV infection see case
definitions (this includes cases detected postmortem) and where
COVID-19, influenza or RSV is reported in any of the four cause of death
fields on the death certificate. Deaths where there is a clear
alternative cause of death (e.g. trauma, suicide) are not recorded as
COVID-19/influenza/RSV deaths. Deaths where there is a period of
complete recovery (as assessed by a clinician) between a COVID-19,
influenza or RSV episode of illness and death, are also not recorded as
deaths.
Test Positivity: Positive tests refer to all positive specimens and
includes duplicates and individuals who were re-tested.
Outbreaks are defined as two or more cases of acute respiratory
infection with the same pathogen (SARS-CoV-2, influenza or respiratory
syncytial virus (RSV)) confirmed by a laboratory test or near patient
test carried out by a health professional, and where there is reason to
consider that these cases may be epidemiologically linked in place and
time.
Other Acute Respiratory Infection (ARI) outbreaks are defined as: Two
or more cases of acute respiratory infection arising within the same
48hr period epidemiologically linked in place: Outbreaks are classified
as Suspect ARI outbreaks, where testing has not been completed, is
pending or has been negative for Influenza, RSV and SARS-CoV-2.
Outbreaks are classified as confirmed if other respiratory pathogens
(ORVs), e.g. Rhinovirus, hMPV, Coronavirus OC43 etc are identified via
laboratory confirmation. The outbreak data presented in this report
includes both confirmed and suspect outbreaks.
Variant working definitions for ‘SARS-CoV-2 variants of concern’
(VOC), ‘SARS-CoV-2 variants of interest’ (VOI) and ‘SARS-CoV-2 variants
under monitoring’ (VUM) are available on the WHO
website and ECDC
website.
Data Sources
The Computerised Infectious Disease Reporting (CIDR) system: CIDR is
the source of statutory notification data on laboratory-confirmed
COVID-19, influenza, RSV (including data on notified, emergency
department, hospitalised and ICU cases and data on cases who died) and
data on outbreaks.
The type/subtype of laboratory confirmed influenza notifications are
reported on the CIDR system. The number of cases hospitalised and
admitted to ICU described in this report relate only to cases notified
during this reporting period, with known hospitalisation/ICU status at
the time of reporting.
Regional Departments of Public Health currently prioritise the
investigation and reporting of outbreaks in settings that benefit most
from public health and clinical intervention. The outbreak data reported
here focuses on these key settings/groups. These settings include acute
hospitals, nursing homes, community hospital/long-stay units,
residential institutions (centres for disabilities, centres for older
people, children’s/TUSLA residential centres and mental health
facilities) and other healthcare settings.
Population denominator data for analyses of CIDR data on notified,
emergency department, hospitalised and ICU cases and deaths are taken
from Census 2022.
Sentinel GP surveillance system: This includes 100 participating
general practices (located in all HSE Health Regions). These practices
report electronically on a weekly basis, the number of patients who
consulted with acute respiratory infection (ARI) and influenza-like
illness (ILI) (identified using International Classification of Primary
Care 2 codes R74 and R80). These practices provide overall and
age-stratified denominator data on the number of registered patients who
have sought care at the practice during the previous three years. The
combined patient population in these practices is estimated to be
approximately 10% of the national population. Sentinel GPs take a
combined nose and throat swab from the first five patients attending
their practice each week who meet the ARI case definition and send these
to the NVRL for testing.
GP Out-of-hours (GPOOHs) services: Five out of 14 GPOOHs services
provide weekly data on the total and age-stratified number of out of
hours calls for 1) all reasons, 2) for self-reported cough and 3) for
self-reported flu. The denominator for calculations of percentage of
calls is the total number of calls for all reasons.
The HSE Performance Management and Improvement Unit (PMIU) provides
daily data on bed occupancy (the number of currents inpatients with
laboratory confirmed COVID-19, influenza and RSV).
Severe Acute Respiratory Infections (SARI) surveillance system: SARI
cases are identified from new admissions through the Emergency
Department, based on clinical symptoms. Patients that develop SARI
during their admission, or who are admitted through alternate routes,
are not included.
National Virus Reference Laboratory (NVRL): The NVRL routinely test
sentinel GP and non-sentinel respiratory specimens for SARS-CoV-2,
influenza, RSV and a panel of other seasonal respiratory viruses (ORV).
The NVRL report on influenza type/subtype of sentinel GP ARI and
non-sentinel respiratory specimens on a weekly basis.
National SARS-CoV-2 Whole Genome Sequencing Surveillance Programme
(NSWGSSP): The SARS-CoV-2 sequencing sampling framework currently
focuses on notified COVID-19 cases with severe disease (hospitalisation,
ICU admission) and deaths, COVID-19 outbreaks in health and care
settings, sentinel surveillance programmes in the community and acute
hospitals and targeted sequencing based on public health risk
assessment/clinical requests and virological changes e.g. new variant of
concern. There is typically a lag time of 1-3 weeks between a COVID-19
case being notified, selected for sequencing and SARS-CoV-2 sequencing
being completed. Therefore, the proportion of notified COVID-19 cases
notified in this time period from whom specimens are ultimately
sequenced will be higher than currently reported here. The HPSC link
sequencing results received from laboratories to epidemiological data on
COVID-19 cases reported on the CIDR system. This report summarises WGS
results and epidemiological data for COVID-19 cases that have been
sequenced in Ireland since week 40 2023 (specimen dates between
01/10/2023 and 30/11/2024). The SARS-CoV-2 sequencing results included
in this report reflect all data available as of 09/12/2024.
National SARS-CoV-2 Wastewater Surveillance Programme: A detailed
description of the process involved for wastewater collection, sampling
and analyses is available in the routinely published national SARS-CoV-2
wastewater surveillance programme reports available here
Appendix
Appendix Table 1: Notified
laboratory confirmed cases of COVID-19, influenza and RSV by age, sex
and HSE health region, from week 40 2024, to week 49 2024. Data source:
CIDR.
Number of cases (incidence per 100,000 population) |
|---|
| All pathogens | COVID-19 | Influenza | RSV |
|---|
Cases | 5,033 (97.7) | 2,405 (46.7) | 1,550 (30.1) | 1,078 (20.9) |
Age groups (years) |
|
|
|
|
<1 | 435 (752.6) | 98 (169.6) | 33 (57.1) | 304 (526.0) |
1-4 | 684 (287.9) | 53 (22.3) | 181 (76.2) | 450 (189.4) |
5-14 | 308 (43.0) | 27 (3.8) | 225 (31.4) | 56 (7.8) |
15-44 | 831 (40.2) | 354 (17.1) | 418 (20.2) | 59 (2.9) |
45-64 | 806 (62.3) | 441 (34.1) | 310 (24.0) | 55 (4.3) |
65-79 | 958 (160.9) | 665 (111.7) | 208 (34.9) | 85 (14.3) |
>80 | 1,011 (558.5) | 767 (423.7) | 175 (96.7) | 69 (38.1) |
Median age (IQR) | 52 (7-76) | 71 (49-82) | 40 (10-64) | 1 (0-12) |
Sex |
|
|
|
|
Male | 2,441 (95.9) | 1,121 (44.1) | 755 (29.7) | 565 (22.2) |
Female | 2,589 (99.4) | 1,283 (49.3) | 795 (30.5) | 511 (19.6) |
HSE Health Regions |
|
|
|
|
Dublin and North East | 1,181 (22.9) | 600 (50.5) | 315 (26.5) | 266 (22.4) |
Dublin and Midlands | 939 (18.2) | 427 (39.6) | 298 (27.7) | 214 (19.9) |
Dublin and South East | 1,063 (20.6) | 527 (54.3) | 346 (35.6) | 190 (19.6) |
South West | 634 (12.3) | 367 (49.6) | 220 (29.7) | 47 (6.3) |
Mid West | 350 (6.8) | 182 (44.1) | 116 (28.1) | 52 (12.6) |
West and North West | 866 (16.8) | 302 (39.8) | 255 (33.6) | 309 (40.7) |
Appendix Table 2:
Hospitalised laboratory confirmed cases of COVID-19, influenza and RSV
by age, sex and HSE health region, from week 40,2024, to week 49 2024.
Data source: CIDR.
Number of cases (incidence per 100,000 population) |
|---|
| All pathogens | COVID-19 | Influenza | RSV |
|---|
Cases | 1,888 (36.7) | 990 (19.2) | 438 (8.5) | 460 (8.9) |
Age groups (years) |
|
|
|
|
<1 | 196 (339.1) | 41 (70.9) | 17 (29.4) | 138 (238.8) |
1-4 | 297 (125.0) | 25 (10.5) | 72 (30.3) | 200 (84.2) |
5-14 | 129 (18.0) | 16 (2.2) | 88 (12.3) | 25 (3.5) |
15-44 | 156 (7.5) | 93 (4.5) | 50 (2.4) | 13 (0.6) |
45-64 | 243 (18.8) | 163 (12.6) | 58 (4.5) | 22 (1.7) |
65-79 | 409 (68.7) | 295 (49.6) | 76 (12.8) | 38 (6.4) |
>80 | 458 (253.0) | 357 (197.2) | 77 (42.5) | 24 (13.3) |
Median age (IQR) | 60 (4-79) | 74 (57-83) | 42 (6-73) | 1 (0-5) |
Sex |
|
|
|
|
Male | 995 (39.1) | 508 (20.0) | 239 (9.4) | 248 (9.7) |
Female | 893 (34.3) | 482 (18.5) | 199 (7.6) | 212 (8.1) |
HSE Health Regions |
|
|
|
|
Dublin and North East | 267 (5.2) | 163 (13.7) | 34 (2.9) | 70 (5.9) |
Dublin and Midlands | 351 (6.8) | 183 (17) | 75 (7) | 93 (8.6) |
Dublin and South East | 362 (7) | 162 (16.7) | 97 (10) | 103 (10.6) |
South West | 291 (5.7) | 190 (25.7) | 78 (10.5) | 23 (3.1) |
Mid West | 194 (3.8) | 104 (25.2) | 55 (13.3) | 35 (8.5) |
West and North West | 423 (8.2) | 188 (24.7) | 99 (13) | 136 (17.9) |
Appendix Table 3: Number
and percentage positive Sentinel GP ARI specimens by respiratory virus,
for week 48 2024, week 49 2024, and the 2024/2025 season. Data source:
NVRL.
| Week 48 2024 (N = 161) | Week 49 2024 (N = 100) | 2024/2025 (N = 1189) |
|---|
Virus | Total positive | % positive | Total positive | % positive | Total positive | % positive |
|---|
SARS-CoV-2 | 10 | 6.2 | 2 | 2 | 56 | 4.7 |
Influenza Virus | 24 | 14.9 | 26 | 26 | 117 | 9.8 |
Respiratory Syncytial Virus (RSV) | 11 | 6.8 | 8 | 8 | 37 | 3.1 |
Rhino/enterovirus | 29 | 18.0 | 15 | 15 | 300 | 25.2 |
Adenovirus | 1 | 0.6 | 0 | 0 | 9 | 0.8 |
Bocavirus | 0 | 0.0 | 0 | 0 | 7 | 0.6 |
Human metapneumovirus (hMPV) | 0 | 0.0 | 0 | 0 | 0 | 0.0 |
Parainfluenza virus type 1 (PIV-1) | 4 | 2.5 | 0 | 0 | 20 | 1.7 |
Parainfluenza virus type 2 (PIV-2) | 5 | 3.1 | 2 | 2 | 27 | 2.3 |
Parainfluenza virus type 3 (PIV-3) | 0 | 0.0 | 1 | 1 | 8 | 0.7 |
Parainfluenza virus type 4 (PIV-4) | 0 | 0.0 | 3 | 3 | 16 | 1.3 |
Appendix Table 4: Number
and percentage positive NVRL non-sentinel respiratory specimens by
respiratory virus, week 48 2024, week 49 2024, and the 2024/2025 season.
Data source: NVRL.
| Week 48 2024 (N = 226) | Week 49 2024 (N = 196) | 2024/2025 (N = 1860) |
|---|
Virus | Total positive | % positive | Total positive | % positive | Total positive | % positive |
|---|
SARS-CoV-2 | 7 | 3.1 | 4 | 2.0 | 76 | 4.1 |
Influenza Virus | 20 | 8.8 | 25 | 12.8 | 131 | 7.0 |
Respiratory Syncytial Virus (RSV) | 24 | 10.6 | 24 | 12.2 | 90 | 4.8 |
Rhino/enterovirus | 33 | 14.6 | 29 | 14.8 | 356 | 19.1 |
Adenovirus | 1 | 0.4 | 1 | 0.5 | 25 | 1.3 |
Bocavirus | 2 | 0.9 | 2 | 1.0 | 13 | 0.7 |
Human metapneumovirus (hMPV) | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 |
Parainfluenza virus type 1 (PIV-1) | 6 | 2.7 | 4 | 2.0 | 30 | 1.6 |
Parainfluenza virus type 2 (PIV-2) | 0 | 0.0 | 2 | 1.0 | 19 | 1.0 |
Parainfluenza virus type 3 (PIV-3) | 1 | 0.4 | 0 | 0.0 | 3 | 0.2 |
Parainfluenza virus type 4 (PIV-4) | 3 | 1.3 | 3 | 1.5 | 25 | 1.3 |
Appendix Table 5:
Influenza type and sub-type distribution among sentinel GP ARI and
non-sentinel respiratory influenza positive specimens, for week 48 2024,
week 49 2024, and the 2024/2025 season. Data source: NVRL.
| | | Influenza A | Influenza B |
|---|
Time period | Specimen source | Total influenza positive | Total | A(H1)pdm09 | A(H3) | A(not subtyped) | Total | B Victoria | B (upspecified) |
|---|
Week 48 2024 | Sentinel GP ARI | 24 | 20 | 19 | 0 | 1 | 4 | 0 | 4 |
Non-sentinel respiratory | 20 | 19 | 14 | 1 | 4 | 1 | 0 | 1 |
Total | 44 | 39 | 33 | 1 | 5 | 5 | 0 | 5 |
Week 49 2024 | Sentinel GP ARI | 26 | 19 | 14 | 2 | 3 | 7 | 0 | 7 |
Non-sentinel respiratory | 25 | 24 | 21 | 1 | 2 | 1 | 0 | 1 |
Total | 51 | 43 | 35 | 3 | 5 | 8 | 0 | 8 |
Season to date | Sentinel GP ARI | 117 | 98 | 69 | 16 | 13 | 19 | 0 | 19 |
Non-sentinel respiratory | 131 | 118 | 93 | 14 | 11 | 13 | 0 | 13 |
Total | 248 | 216 | 162 | 30 | 24 | 32 | 0 | 32 |
Appendix Table 6: RSV type
distribution among sentinel GP ARI and non-sentinel respiratory RSV
positive specimens, for week 48, 2024 week 49 2024, and the 2024/2025
season. Data source: NVRL.
Time period | Specimen source | Total RSV positive | RSV A | RSV B | RSV (unspecified) |
|---|
Week 48 2024 | Sentinel GP ARI | 11 | 5 | 6 | 0 |
Non-sentinel respiratory | 24 | 13 | 11 | 0 |
Total | 35 | 18 | 17 | 0 |
Week 49 2024 | Sentinel GP ARI | 8 | 6 | 2 | 0 |
Non-sentinel respiratory | 24 | 12 | 12 | 0 |
Total | 32 | 18 | 14 | 0 |
Season to date | Sentinel GP ARI | 37 | 18 | 19 | 0 |
Non-sentinel respiratory | 90 | 46 | 44 | 0 |
Total | 127 | 64 | 63 | 0 |
